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  • 251. Segersson, David
    et al.
    Eneroth, Kristina
    Gidhagen, Lars
    Johansson, Christer
    Omstedt, Gunnar
    Engström Nylén, Anders
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Health Impact of PM10, PM2.5 and Black Carbon Exposure Due to Different Source Sectors in Stockholm, Gothenburg and Umea, Sweden2017In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 14, no 7, article id 742Article in journal (Refereed)
    Abstract [en]

    The most important anthropogenic sources of primary particulate matter (PM) in ambient air in Europe are exhaust and non-exhaust emissions from road traffic and combustion of solid biomass. There is convincing evidence that PM, almost regardless of source, has detrimental health effects. An important issue in health impact assessments is what metric, indicator and exposure-response function to use for different types of PM. The aim of this study is to describe sectorial contributions to PM exposure and related premature mortality for three Swedish cities: Gothenburg, Stockholm and Umea. Exposure is calculated with high spatial resolution using atmospheric dispersion models. Attributed premature mortality is calculated separately for the main local sources and the contribution from long-range transport (LRT), applying different relative risks. In general, the main part of the exposure is due to LRT, while for black carbon, the local sources are equally or more important. The major part of the premature deaths is in our assessment related to local emissions, with road traffic and residential wood combustion having the largest impact. This emphasizes the importance to resolve within-city concentration gradients when assessing exposure. It also implies that control actions on local PM emissions have a strong potential in abatement strategies.

  • 252.
    Segerstedt, Bo
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Health Effects from Road Dust2006In: ISEE/ISEA 2006 Conference Abstracts Supplement: Session Abstracts: Abstracts, Cambridge, MA: Blackwell Scientific Publications , 2006, Vol. 17, no 6, p. S233-Conference paper (Refereed)
    Abstract [en]

    TAB3-PD-12

    Whether coarse particles dominating road dust influence health or not is a question in the matter of measures of priority (remedial measures), among others. Within this project, we investigated how particulate matter (PM10), when characterized by high levels of road dust, affects daily mortality, acute hospital admissions, and emergency department visits in greater Stockholm.

    The study covered the period of 1994 to 2002. Daily hospital admissions and deaths were collected from registers maintained by the Centre for Epidemiology at the National Board of Health and Welfare. Records of acute visits at hospitals for asthma were obtained from Stockholm County Council. A total of 457 days characterized by high levels of road dust were identified using the 85th percentile for local non-exhaust PM10 time-series adjusted for rural background PM10 and urban levels of NOx representing local exhaust emissions. Data were analyzed and modelled with additative Poisson regression, following the strategy used in the APHEA project. In other words, smoothed functions for potential nonlinear relations with confounders are used in conjunction with linear terms, in order to achieve parameter estimates for the short-term effect of pollutants.

    The estimated effect of PM10 on asthma visits was 3.4% per 10 μg/m3for road dust days.

    With a 10.2 μg/m3 higher average urban background level of PM10(compared with days not classifed as road dust days), a mean of 20.5 daily respiratory admissions and a estimated coefficient of 0.0021 (0.00165), expressing a relative change of 2.1% per 10 μg/m3 PM10,roughly 200 respiratory hospital admissions were attributed to the road dust PM10 during the study period. There was no evidence that road dust affects hospital admissions for cardiovascular diseases. This might indicate that smaller, combustion-related particles are behind the connection betwen PM10 and acute cases of cardiac admissions that has been found even in Stockholm.

    The results of this study, as well as the epidemiologic litterature about mineral particles and the coarse fractions, gives evidence for road dust to increase respiratory problems and the acute visits, as well as hospital admissions for the matter.

  • 253. Sera, Francesco
    et al.
    Armstrong, Ben
    Tobias, Aurelio
    Vicedo-Cabrera, Ana Maria
    Åström, Christofer
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Bell, Michelle L
    Chen, Bing-Yu
    de Sousa Zanotti Stagliorio Coelho, Micheline
    Matus Correa, Patricia
    Cruz, Julio Cesar
    Dang, Tran Ngoc
    Hurtado-Diaz, Magali
    Do Van, Dung
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Guo, Yue Leon
    Guo, Yuming
    Hashizume, Masahiro
    Honda, Yasushi
    Iñiguez, Carmen
    Jaakkola, Jouni J K
    Kan, Haidong
    Kim, Ho
    Lavigne, Eric
    Michelozzi, Paola
    Ortega, Nicolas Valdes
    Osorio, Samuel
    Pascal, Mathilde
    Ragettli, Martina S
    Ryti, Niilo R I
    Saldiva, Paulo Hilario Nascimento
    Schwartz, Joel
    Scortichini, Matteo
    Seposo, Xerxes
    Tong, Shilu
    Zanobetti, Antonella
    Gasparrini, Antonio
    How urban characteristics affect vulnerability to heat and cold: a multi-country analysis2019In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 48, no 4, p. 1101-1112Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The health burden associated with temperature is expected to increase due to a warming climate. Populations living in cities are likely to be particularly at risk, but the role of urban characteristics in modifying the direct effects of temperature on health is still unclear. In this contribution, we used a multi-country dataset to study effect modification of temperature-mortality relationships by a range of city-specific indicators.

    METHODS: We collected ambient temperature and mortality daily time-series data for 340 cities in 22 countries, in periods between 1985 and 2014. Standardized measures of demographic, socio-economic, infrastructural and environmental indicators were derived from the Organisation for Economic Co-operation and Development (OECD) Regional and Metropolitan Database. We used distributed lag non-linear and multivariate meta-regression models to estimate fractions of mortality attributable to heat and cold (AF%) in each city, and to evaluate the effect modification of each indicator across cities.

    RESULTS: Heat- and cold-related deaths amounted to 0.54% (95% confidence interval: 0.49 to 0.58%) and 6.05% (5.59 to 6.36%) of total deaths, respectively. Several city indicators modify the effect of heat, with a higher mortality impact associated with increases in population density, fine particles (PM2.5), gross domestic product (GDP) and Gini index (a measure of income inequality), whereas higher levels of green spaces were linked with a decreased effect of heat.

    CONCLUSIONS: This represents the largest study to date assessing the effect modification of temperature-mortality relationships. Evidence from this study can inform public-health interventions and urban planning under various climate-change and urban-development scenarios.

  • 254. Sigsgaard, Torben
    et al.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Annesi-Maesano, Isabella
    Blomberg, Anders
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Pulmonary Medicine.
    Bølling, Anette
    Boman, Christoffer
    Umeå University, Faculty of Science and Technology, Department of Applied Physics and Electronics.
    Bønløkke, Jakob
    Brauer, Michael
    Bruce, Nigel
    Héroux, Marie-Eve
    Hirvonen, Maija-Riitta
    Kelly, Frank
    Künzli, Nino
    Lundbäck, Bo
    Moshammer, Hanns
    Noonan, Curtis
    Pagels, Joachim
    Sallsten, Gerd
    Sculier, Jean-Paul
    Brunekreef, Bert
    Health impacts of anthropogenic biomass burning in the developed world2015In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 46, no 6, p. 1577-1588Article in journal (Refereed)
    Abstract [en]

    Climate change policies have stimulated a shift towards renewable energy sources such as biomass. The economic crisis of 2008 has also increased the practice of household biomass burning as it is often cheaper than using oil, gas or electricity for heating. As a result, household biomass combustion is becoming an important source of air pollutants in the European Union. This position paper discusses the contribution of biomass combustion to pollution levels in Europe, and the emerging evidence on the adverse health effects of biomass combustion products. Epidemiological studies in the developed world have documented associations between indoor and outdoor exposure to biomass combustion products and a range of adverse health effects. A conservative estimate of the current contribution of biomass smoke to premature mortality in Europe amounts to at least 40 000 deaths per year. We conclude that emissions from current biomass combustion products negatively affect respiratory and, possibly, cardiovascular health in Europe. Biomass combustion emissions, in contrast to emissions from most other sources of air pollution, are increasing. More needs to be done to further document the health effects of biomass combustion in Europe, and to reduce emissions of harmful biomass combustion products to protect public health.

  • 255.
    Sommar, Johan Nilsson
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Ek, Alexandra
    Middelveld, Roelinde
    Bjerg, Anders
    Dahlén, Sven-Erik
    Janson, Christer
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Quality of life in relation to the traffic pollution indicators NO2 and NOx: results from the Swedish GA2LEN survey2014In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 1, p. e000039-Article in journal (Refereed)
    Abstract [en]

    Background Asthma is a chronic disease that may affect daily activities and quality of life. Asthmatics have higher incidence of chronic rhinosinusitis (CRS) and asthma is associated with sinonasal inflammation and nasal symptoms, that all impair quality of life. Worsening of asthma has been found associated with levels of nitrogen dioxide as traffic indicator.

    Aims The aim of the study was to evaluate the impact of traffic pollution indicated by nitrogen oxides (NO2 and NOx) on quality of life in asthmatic persons, individuals with CRS and controls.

    Methods Within the Swedish Ga2len (Global Allergy and Asthma European Network), 605 asthmatics with and without CRS, 110 individuals with CRS only and 226 controls from four cities were surveyed. The mini Asthma Quality of life Questionnaire (mAQLQ) and the Euro Quality of Life (EQ-5D) health questionnaire were used. Air pollution concentrations at the home address were modelled using dispersion models.

    Results Levels of NO2 (geometric mean 10.1 μg/m3 (95% CI 9.80 to 10.5) and NOx (12.1 μg/m3, 11.7 to 12.6) were similar among conditions (controls, asthmatics, individuals with CRS and asthmatics with CRS). The mAQLQ overall score was not found associated with levels of NO2 or NOx, with or without adjustments, and neither was scores within each of the four domains of mAQLQ: symptoms, activity limitations, emotional functions and effects of environmental stimuli. The mean EQ-5D index value, based on the five dimensions mobility, self-care, usual activities, pain/discomfort and anxiety depression, was also found unrelated to NO2 and NOx.

    Conclusions At moderate exposure levels traffic pollution appears not to affect quality of life.

  • 256. Storaas, Torgeir
    et al.
    Zock, Jan-Paul
    Morano, Ana Espinosa
    Holm, Mathias
    Bjørnsson, Eythor
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Gislason, Thorarinn
    Janson, Christer
    Norback, Dan
    Omenaas, Ernst
    Schlünssen, Vivi
    Torén, Kjell
    Svanes, Cecilie
    Incidence of rhinitis and asthma related to welding in Northern Europe2015In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 46, no 5, p. 1290-1297Article in journal (Refereed)
    Abstract [en]

    Welding-related asthma is well recognised but less is known about rhinitis in relation to welding. The aim here, was to study associations between welding, rhinitis and asthma in a general population sample, and factors influencing selection into and out of a welding occupation.Adult-onset asthma and non-infectious rhinitis were investigated in the international multicentre population-based Respiratory Health in Northern Europe (RHINE) study, including 16 191 responders aged 26-54 years. Ever welding (n=2181), welding >25% of working time (n=747), and welding in stainless steel >6 months (n=173) were assessed by questionnaire. Subjects with rhinitis or asthma onset when aged <18 years were excluded. Incidence rates for asthma and rhinitis were calculated from year of disease onset, and start and end of welding job. Cox's proportional hazard models adjusting for age, sex, parental education and study centre, and Kaplan-Meier curves were used.Rhinitis incidence was higher among welders (hazard ratio (HR) 1.4, 95% CI 1.3-1.6), consistent in men and women, and across centres (pheterogeneity=0.4). In men, asthma incidence was higher among welders (HR 1.4, 95% CI 1.04-1.97). Quitting welding was indicated higher after adult-onset rhinitis (HR 1.1, 95% CI 1.0-1.3).Adult-onset rhinitis and asthma was higher among welders, consistent across population samples from Northern Europe. No pre-employment selection was found, whereas selection out of welding jobs was suggested.

  • 257. Sundbom, F
    et al.
    Lindberg, E
    Bjerg, A
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Franklin, Karl
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Pulmonary Medicine. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Gunnbjörnsdottir, M
    Middelveld, R
    Torén, K
    Janson, C
    Asthma symptoms and nasal congestion as independent risk factors for insomnia in a general population: results from the GA (2) LEN survey2013In: Allergy. European Journal of Allergy and Clinical Immunology, ISSN 0105-4538, E-ISSN 1398-9995, Vol. 68, no 2, p. 213-219Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Asthma and rhinitis have been related to insomnia. The aim of this study was to further analyse the association between asthma, nasal symptoms and insomnia and to identify risk factors for sleep disturbance among patients with asthma, in a large population-based set of material.

    METHOD: In 2008, a postal questionnaire was sent to a random sample of 45 000 adults in four Swedish cities. The questionnaire included questions on insomnia, asthma, rhinitis, weight, height, tobacco use and physical activity.

    RESULTS: Twenty-five thousand six hundred and ten subjects participated. Asthma was defined as either current medication for asthma or at least one attack of asthma during the last 12 months, and 1830 subjects (7.15%) were defined as asthmatics. The prevalence of insomnia symptoms was significantly higher among asthmatics than non-asthmatics (47.3% vs 37.2%, <0.0001). In the subgroup reporting both asthma and nasal congestion, 55.8% had insomnia symptoms compared with 35.3% in subjects without both asthma and nasal congestion. The risk of insomnia increased with the severity of asthma, and the adjusted OR for insomnia was 2.65 in asthmatics with three symptoms compared with asthmatics without symptoms. Nasal congestion (OR 1.50), obesity (OR 1.54) and smoking (OR 1.71) also increased the risk of insomnia.

    CONCLUSION: Insomnia remains a common problem among asthmatics. Uncontrolled asthma and nasal congestion are important, treatable risk factors for insomnia. Lifestyle factors, such as smoking and obesity, are also risk factors for insomnia among asthmatics.

  • 258. Sundström, Johan
    et al.
    Söderholm, Martin
    Söderberg, Stefan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Alfredsson, Lars
    Andersson, Martin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Bellocco, Rino
    Björck, Martin
    Broberg, Per
    Eriksson, Maria
    Eriksson, Marie
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Fransson, Eleonor I
    Giedraitis, Vilmantas
    Theorell-Haglöw, Jenny
    Hallqvist, Johan
    Hansson, Per-Olof
    Heller, Susanne
    Håkansson, Niclas
    Ingelsson, Martin
    Janson, Christer
    Järvholm, Bengt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Khalili, Payam
    Knutsson, Anders
    Lager, Anton
    Lagerros, Ylva Trolle
    Larsson, Susanna C
    Leander, Karin
    Leppert, Jerzy
    Lind, Lars
    Lindberg, Eva
    Magnusson, Cecilia
    Magnusson, Patrik K E
    Malfert, Mauricio
    Michaëlsson, Karl
    Nilsson, Peter
    Olsson, Håkan
    Pedersen, Nancy L
    Pennlert, Johanna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Rosenblad, Andreas
    Rosengren, Annika
    Torén, Kjell
    Wanhainen, Anders
    Wolk, Alicja
    Engström, Gunnar
    Svennblad, Bodil
    Wiberg, Bernice
    Risk factors for subarachnoid haemorrhage: a nationwide cohort of 950 000 adults2019In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 48, no 6, p. 2018-2025Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Subarachnoid haemorrhage (SAH) is a devastating disease, with high mortality rate and substantial disability among survivors. Its causes are poorly understood. We aimed to investigate risk factors for SAH using a novel nationwide cohort consortium.

    METHODS: We obtained individual participant data of 949 683 persons (330 334 women) between 25 and 90 years old, with no history of SAH at baseline, from 21 population-based cohorts. Outcomes were obtained from the Swedish Patient and Causes of Death Registries.

    RESULTS: During 13 704 959 person-years of follow-up, 2659 cases of first-ever fatal or non-fatal SAH occurred, with an age-standardized incidence rate of 9.0 [95% confidence interval (CI) (7.4-10.6)/100 000 person-years] in men and 13.8 [(11.4-16.2)/100 000 person-years] in women. The incidence rate increased exponentially with higher age. In multivariable-adjusted Poisson models, marked sex interactions for current smoking and body mass index (BMI) were observed. Current smoking conferred a rate ratio (RR) of 2.24 (95% CI 1.95-2.57) in women and 1.62 (1.47-1.79) in men. One standard deviation higher BMI was associated with an RR of 0.86 (0.81-0.92) in women and 1.02 (0.96-1.08) in men. Higher blood pressure and lower education level were also associated with higher risk of SAH.

    CONCLUSIONS: The risk of SAH is 45% higher in women than in men, with substantial sex differences in risk factor strengths. In particular, a markedly stronger adverse effect of smoking in women may motivate targeted public health initiatives.

  • 259. Sunyer, J
    et al.
    Jarvis, D
    Gotschi, T
    Garcia-Esteban, R
    Jacquemin, B
    Aguilera, I
    Ackerman, U
    de Marco, R
    Forsberg, B
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Occupational and Enviromental Medicine.
    Gislason, T
    Heinrich, J
    Norbäck, D
    Villani, S
    Künzli, N
    Chronic bronchitis and urban air pollution in an international study.2006In: Occup Environ Med, ISSN 1470-7926, Vol. 63, no 12, p. 836-43Article in journal (Refereed)
  • 260. Svanes, C.
    et al.
    Koplin, J.
    Janson, C.
    Omenaas, E.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Gislason, T.
    Joegi, R.
    Gomez, Real F.
    Schlunssen, V
    Holm, M.
    Johannessen, A.
    Change in prevalence of asthma in three generations born 1900-20002015In: Respirology (Carlton South. Print), ISSN 1323-7799, E-ISSN 1440-1843, Vol. 20, p. 67-67Article in journal (Other academic)
  • 261. Svanes, Cecilie
    et al.
    Koplin, Jennifer
    Skulstad, Svein Magne
    Johannessen, Ane
    Bertelsen, Randi Jakobsen
    Benediktsdottir, Byndis
    Bråbäck, Lennart
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Elie Carsin, Anne
    Dharmage, Shyamali
    Dratva, Julia
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Gislason, Thorarinn
    Heinrich, Joachim
    Holm, Mathias
    Janson, Christer
    Jarvis, Deborah
    Jögi, Rain
    Krauss-Etschmann, Susanne
    Lindberg, Eva
    Macsali, Ferenc
    Malinovschi, Andrei
    Modig, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Centre for International Health, University of Bergen, Norway.
    Norbäck, Dan
    Omenaas, Ernst
    Waatevik Saure, Eirunn
    Sigsgaard, Torben
    Skorge, Trude Duelien
    Svanes, Øistein
    Torén, Kjell
    Torres, Carl
    Schlünssen, Vivi
    Gomez Real, Francisco
    Father's environment before conception and asthma risk in his children: a multi-generation analysis of the respiratory health in northern Europe study2017In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 49, no 1, p. 235-245Article in journal (Refereed)
    Abstract [en]

    Background: Whereas it is generally accepted that maternal environment plays a key role in child health, emerging evidence suggests that paternal environment before conception also impacts child health. We aimed to investigate the association between children’s asthma risk and parental smoking and welding exposures prior to conception. Methods: In a longitudinal, multi-country study, parents of 24 168 offspring aged 2–51 years provided information on their life-course smoking habits, occupational exposure to welding and metal fumes, and offspring’s asthma before/after age 10 years and hay fever. Logistic regressions investigated the relevant associations controlled for age, study centre, parental characteristics (age, asthma, education) and clustering by family. Results: Non-allergic early-onset asthma (asthma without hay fever, present in 5.8%) was more common in the offspring with fathers who smoked before conception {odds ratio [OR] = 1.68 [95% confidence interval (CI) = 1.18–2.41]}, whereas mothers’ smoking before conception did not predict offspring asthma. The risk was highest if father started smoking before age 15 years [3.24 (1.67–6.27)], even if he stopped more than 5 years before conception [2.68 (1.17–6.13)]. Fathers’ pre-conception welding was independently associated with non-allergic asthma in his offspring [1.80 (1.29–2.50)]. There was no effect if the father started welding or smoking after birth. The associations were consistent across countries. Conclusions: Environmental exposures in young men appear to influence the respiratory health of their offspring born many years later. Influences during susceptible stages of spermatocyte development might be important and needs further investigation in humans. We hypothesize that protecting young men from harmful exposures may lead to improved respiratory health in future generations.

  • 262. Svanes, Oistein
    et al.
    Skorge, Trude Duelien
    Johannessen, Ane
    Bertelsen, Randi Jacobsen
    Bratveit, Magne
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Gislason, Thorarin
    Holm, Mathias
    Janson, Christer
    Joegi, Rain
    Macsali, Ferenc
    Norback, Dan
    Omenaas, Ernst Reidar
    Real, Francisco Gomez
    Schlunssen, Vivi
    Sigsgaard, Torben
    Wieslander, Gunilla
    Zock, Jan-Paul
    Aasen, Tor
    Dratva, Julia
    Svanes, Cecilie
    Respiratory Health in Cleaners in Northern Europe: Is Susceptibility Established in Early Life?2015In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, no 7, article id e0131959Article in journal (Refereed)
    Abstract [en]

    Rationale There is some evidence that maternal smoking increases susceptibility to personal smoking's detrimental effects. One might question whether early life disadvantage might influence susceptibility to occupational exposure. Objectives In this cross-sectional study we investigated respiratory symptoms, asthma and self-reported chronic obstructive pulmonary disease (COPD) as related to working as a cleaner in Northern European populations, and whether early life factors influenced susceptibility to occupational cleaning's unhealthy effects. Methods The RHINE III questionnaire study assessed occupational cleaning in 13,499 participants. Associations with respiratory symptoms, asthma and self-reported COPD were analysed with multiple logistic regressions, adjusting for sex, age, smoking, educational level, parent's educational level, BMI and participating centre. Interaction of occupational cleaning with early life disadvantage (maternal smoking, severe respiratory infection < 5 years, born during winter months, maternal age at birth > 35 years) was investigated. Main Results Among 2138 ever-cleaners the risks of wheeze (OR 1.4, 95% CI 1.3-1.6), adult-onset asthma (1.5 [1.2-1.8]) and self-reported COPD (1.7 [1.3-2.2]) were increased. The risk increased with years in occupational cleaning (adult-onset asthma: <= 1 year 0.9 [0.7-1.3]; 1-4 years 1.5 [1.1-2.0]; >= 4 years 1.6 [1.2-2.1]). The association of wheeze with cleaning activity >= 4 years was significantly stronger for those with early life disadvantage than in those without (1.8 [1.5-2.3] vs. 1.3 [0.96-1.8]; pinteraction 0.035). Conclusions Occupational cleaners had increased risk of asthma and self-reported COPD. Respiratory symptom risk was particularly increased in persons with factors suggestive of early life disadvantage. We hypothesize that early life disadvantage may increase airway vulnerability to harmful exposure from cleaning agents later in life.

  • 263. Svanes, Øistein
    et al.
    Bertelsen, Randi J.
    Lygre, Stein H. L.
    Carsin, Anne E.
    Antó, Josep M.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    García-García, José M.
    Gullón, José A.
    Heinrich, Joachim
    Holm, Mathias
    Kogevinas, Manolis
    Urrutia, Isabel
    Leynaert, Bénédicte
    Moratalla, Jesús M.
    Le Moual, Nicole
    Lytras, Theodore
    Norbäck, Dan
    Nowak, Dennis
    Olivieri, Mario
    Pin, Isabelle
    Probst-Hensch, Nicole
    Schlünssen, Vivi
    Sigsgaard, Torben
    Skorge, Trude D.
    Villani, Simona
    Jarvis, Debbie
    Zock, Jan P.
    Svanes, Cecilie
    Cleaning at Home and at Work in Relation to Lung Function Decline and Airway Obstruction2018In: American Journal of Respiratory and Critical Care Medicine, ISSN 1073-449X, E-ISSN 1535-4970, Vol. 197, no 9, p. 1157-1163Article in journal (Refereed)
    Abstract [en]

    Rationale: Cleaning tasks may imply exposure to chemical agents with potential harmful effects to the respiratory system, and increased risk of asthma and respiratory symptoms among professional cleaners and in persons cleaning at home has been reported. Long-term consequences of cleaning agents on respiratory health are, however, not well described.

    Objectives: This study aimed to investigate long-term effects of occupational cleaning and cleaning at home on lung function decline and airway obstruction.

    Methods: The European Community Respiratory Health Survey (ECRHS) investigated a multicenter population-based cohort at three time points over 20 years. A total of 6,235 participants with at least one lung function measurement from 22 study centers, who in ECRHS II responded to questionnaire modules concerning cleaning activities between ECRHS I and ECRHS II, were included. The data were analyzed with mixed linear models adjusting for potential confounders.

    Measurements and Main Results: As compared with women not engaged in cleaning (ΔFEV1 = −18.5 ml/yr), FEV1 declined more rapidly in women responsible for cleaning at home (−22.1; P = 0.01) and occupational cleaners (−22.4; P = 0.03). The same was found for decline in FVC (ΔFVC = −8.8 ml/yr; −13.1, P = 0.02; and −15.9, P = 0.002; respectively). Both cleaning sprays and other cleaning agents were associated with accelerated FEV1 decline (−22.0, P = 0.04; and −22.9, P = 0.004; respectively). Cleaning was not significantly associated with lung function decline in men or with FEV1/FVC decline or airway obstruction.

    Conclusions: Women cleaning at home or working as occupational cleaners had accelerated decline in lung function, suggesting that exposures related to cleaning activities may constitute a risk to long-term respiratory health.

  • 264. Thurston, George D
    et al.
    Kipen, Howard
    Annesi-Maesano, Isabella
    Balmes, John
    Brook, Robert D
    Cromar, Kevin
    De Matteis, Sara
    Forastiere, Francesco
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Frampton, Mark W
    Grigg, Jonathan
    Heederik, Dick
    Kelly, Frank J
    Kuenzli, Nino
    Laumbach, Robert
    Peters, Annette
    Rajagopalan, Sanjay T
    Rich, David
    Ritz, Beate
    Samet, Jonathan M
    Sandstrom, Thomas
    Sigsgaard, Torben
    Sunyer, Jordi
    Brunekreef, Bert
    A joint ERS/ATS policy statement: what constitutes an adverse health effect of air pollution? An analytical framework2017In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 49, no 1, article id 1600419Article in journal (Refereed)
    Abstract [en]

    The American Thoracic Society has previously published statements on what constitutes an adverse effect on health of air pollution in 1985 and 2000. We set out to update and broaden these past statements that focused primarily on effects on the respiratory system. Since then, many studies have documented effects of air pollution on other organ systems, such as on the cardiovascular and central nervous systems. In addition, many new biomarkers of effects have been developed and applied in air pollution studies.This current report seeks to integrate the latest science into a general framework for interpreting the adversity of the human health effects of air pollution. Rather than trying to provide a catalogue of what is and what is not an adverse effect of air pollution, we propose a set of considerations that can be applied in forming judgments of the adversity of not only currently documented, but also emerging and future effects of air pollution on human health. These considerations are illustrated by the inclusion of examples for different types of health effects of air pollution.

  • 265. Timm, Signe
    et al.
    Frydenberg, Morten
    Janson, Christer
    Campbell, Brittany
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Gislason, Thorarinn
    Holm, Mathias
    Jogi, Rain
    Omenaas, Ernst
    Sigsgaard, Torben
    Svanes, Cecilie
    Schlünssen, Vivi
    The Urban-Rural Gradient In Asthma: A Population-Based Study in Northern Europe2016In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 13, no 1, p. 93-Article in journal (Refereed)
    Abstract [en]

    The early life environment appears to have a persistent impact on asthma risk. We hypothesize that environmental factors related to rural life mediate lower asthma prevalence in rural populations, and aimed to investigate an urban-rural gradient, assessed by place of upbringing, for asthma. The population-based Respiratory Health In Northern Europe (RHINE) study includes subjects from Denmark, Norway, Sweden, Iceland and Estonia born 1945-1973. The present analysis encompasses questionnaire data on 11,123 RHINE subjects. Six categories of place of upbringing were defined: farm with livestock, farm without livestock, village in rural area, small town, city suburb and inner city. The association of place of upbringing with asthma onset was analysed with Cox regression adjusted for relevant confounders. Subjects growing up on livestock farms had less asthma (8%) than subjects growing up in inner cities (11%) (hazard ratio 0.72 95% CI 0.57-0.91), and a significant urban-rural gradient was observed across six urbanisation levels (p = 0.02). An urban-rural gradient was only evident among women, smokers and for late-onset asthma. Analyses on wheeze and place of upbringing revealed similar results. In conclusion, this study suggests a protective effect of livestock farm upbringing on asthma development and an urban-rural gradient in a Northern European population.

  • 266. Timm, Signe
    et al.
    Svanes, Cecilie
    Janson, Christer
    Sigsgaard, Torben
    Johannessen, Ane
    Gislason, Thorarinn
    Jogi, Rain
    Omenaas, Ernst
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Torén, Kjell
    Holm, Mathias
    Bråbäck, Lennart
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Schlünssen, Vivi
    Place of upbringing in early childhood as related to inflammatory bowel diseases in adulthood: a population-based cohort study in Northern Europe2014In: European Journal of Epidemiology, ISSN 0393-2990, E-ISSN 1573-7284, Vol. 29, no 6, p. 429-437Article in journal (Refereed)
    Abstract [en]

    Background The two inflammatory bowel diseases (IBD), ulcerative colitis and Crohn's disease, has increased rapidly during the twentieth century, but the aetiology is still poorly understood. Impaired immunological competence due to decreasing biodiversity and altered microbial stimulation is a suggested explanation.

    Objective Place of upbringing was used as a proxy for the level and diversity of microbial stimulation to investigate the effects on the prevalence of IBD in adulthood.

    Methods Respiratory Health in Northern Europe (RHINE) III is a postal follow-up questionnaire of the European Community Respiratory Health Survey (ECRHS) cohorts established in 1989-1992. The study population was 10,864 subjects born 1945-1971 in Denmark, Norway, Sweden, Iceland and Estonia, who responded to questionnaires in 2000-2002 and 2010-2012. Data were analysed in logistic and Cox regression models taking age, sex, smoking and body mass index into consideration.

    Results Being born and raised on a livestock farm the first 5 years of life was associated with a lower risk of IBD compared to city living in logistic (OR 0.54, 95 % CI 0.31; 0.94) and Cox regression models (HR 0.55, 95 % CI 0.31; 0.98). Random-effect meta-analysis did not identify geographical difference in this association. Furthermore, there was a significant trend comparing livestock farm living, village and city living (p < 0.01). Sub-analyses showed that the protective effect was only present among subjects born after 1952 (OR 0.25, 95 % CI 0.11; 0.61).

    Conclusion This study suggests a protective effect from livestock farm living in early childhood on the occurrence of IBD in adulthood, however only among subjects born after 1952. We speculate that lower microbial diversity is an explanation for the findings.

  • 267. Tomassen, P.
    et al.
    Jarvis, D.
    Newson, R.
    Van Ree, R.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Howarth, P.
    Janson, C.
    Kowalski, M. L.
    Krämer, U.
    Matricardi, P. M.
    Middelveld, R. J. M.
    Todo-Bom, A.
    Toskala, E.
    Thilsing, T.
    Brożek, G.
    Van Drunen, C.
    Burney, P.
    Bachert, C.
    Staphylococcus aureus enterotoxin-specific IgE is associated with asthma in the general population: a GA2LEN study2013In: Allergy. European Journal of Allergy and Clinical Immunology, ISSN 0105-4538, E-ISSN 1398-9995, Vol. 68, no 10, p. 1289-1297Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Specific IgE to Staphylococcus aureus enterotoxins (SE-IgE) has been associated with asthma. In the general population, we aimed to determine the prevalence of and risk factors for serum SE-IgE and to examine the association with asthma.

    METHODS: A postal questionnaire was sent to a random sample of adults in 19 centers across Europe. A random sample of respondents was invited for clinical examination upon which they answered a questionnaire, underwent skin prick tests (SPTs) for common aeroallergens, and provided blood for measurement of total IgE and SE-IgE. Risks were analyzed within centers using weighted logistic regression, and overall estimates calculated using fixed-effects meta-analysis.

    RESULTS: 2908 subjects were included in this analysis. Prevalence of positive SE-IgE was 29.3%; no significant geographic variation was observed. In contrast to positive skin prick tests, SE-IgE was more common in smokers (<15 pack-year: OR 1.11, P = 0.079, ≥15 pack-year: OR 1.70, P < 0.001), and prevalence did not decrease in older age-groups or in those with many siblings. Total IgE concentrations were higher in those with positive SE-IgE than in those with positive SPT. SE-IgE was associated with asthma (OR 2.10, 95% confidence interval [1.60-2.76], P = 0.001) in a concentration-dependent manner. This effect was independent of SPT result and homogeneous across all centers.

    CONCLUSIONS: We report for the first time that SE-IgE is common in the general population throughout Europe and that its risk factors differ from those of IgE against aeroallergens. This is the first study to show that SE-IgE is significantly and independently associated with asthma in the general population.

  • 268.
    Tornevi, Andreas
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Axelsson, Gösta
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Association between precipitation upstream of a drinking water utility and nurse advice calls relating to acute gastrointestinal illnesses2013In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 8, no 7, article id e69918Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The River Göta Älv is a source of fresh-water for the City of Gothenburg (Sweden). We recently identified a clear association between upstream precipitation and indicator bacteria concentrations in the river water outside the intake to the drinking water utility. This study aimed to determine if variation in the incidence of acute gastrointestinal illnesses is associated with upstream precipitation.

    METHODS: We acquired data, covering 1494 days, on the daily number of telephone calls to the nurse advice line from citizens in Gothenburg living in areas with Göta Älv as a fresh-water supply. We separated calls relating to gastrointestinal illnesses from other medical concerns, and analyzed their association with precipitation using a distributed lag non-linear Poisson regression model, adjusting for seasonal patterns and covariates. We used a 0-21-day lag period for precipitation to account for drinking water delivery times and incubation periods of waterborne pathogens.

    RESULTS: The study period contained 25,659 nurse advice calls relating to gastrointestinal illnesses. Heavy rainfall was associated with increased calls the same day and around 5-6 days later. Consecutive days of wet weather were also found to be associated with an increase in the daily number of gastrointestinal concerns. No associations were identified between precipitation and nurse advice calls relating to other medical concerns.

    CONCLUSION: An increase in nurse advice calls relating to gastrointestinal illnesses around 5-6 days after heavy rainfall is consistent with a hypothesis that the cause could be related to drinking water due to insufficient barriers in the drinking water production, suggesting the need for improved drinking water treatment.

  • 269.
    Tornevi, Andreas
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Barregård, Lars
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Precipitation and primary health care visits for gastrointestinal illness in Gothenburg, Sweden2015In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, no 5, article id e0128487Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The river Göta Älv is a source of freshwater for the City of Gothenburg, Sweden, and we recently identified a clear influence of upstream precipitation on concentrations of indicator bacteria in the river water, as well as an association with the daily number of phone calls to the nurse advice line related to acute gastrointestinal illnesses (AGI calls). This study aimed to examine visits to primary health-care centers owing to similar symptoms (AGI visits) in the same area, to explore associations with precipitation, and to compare variability in AGI visits and AGI calls.

    METHODS: We obtained data covering six years (2007-2012) of daily AGI visits and studied their association with prior precipitation (0-28 days) using a distributed lag nonlinear Poisson regression model, adjusting for seasonal patterns and covariates. In addition, we studied the effects of prolonged wet and dry weather on AGI visits. We analyzed lagged short-term relations between AGI visits and AGI calls, and we studied differences in their seasonal patterns using a binomial regression model.

    RESULTS: The study period saw a total of 17,030 AGI visits, and the number of daily visits decreased on days when precipitation occurred. However, prolonged wet weather was associated with an elevated number of AGI visits. Differences in seasonality patterns were observed between AGI visits and AGI calls, as visits were relatively less frequent during winter and relatively more frequent in August, and only weak short-term relations were found.

    CONCLUSION: AGI visits and AGI calls seems to partly reflect different types of AGI illnesses, and the patients' choice of medical contact (in-person visits versus phone calls) appears to depend on current weather conditions. An association between prolonged wet weather and increased AGI visits supports the hypothesis that the drinking water is related to an increased risk of AGI illnesses.

  • 270.
    Tornevi, Andreas
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Bergstedt, Olof
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Precipitation Effects on Microbial Pollution in a River: Lag Structures and Seasonal Effect Modification2014In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 9, no 5Article in journal (Refereed)
    Abstract [en]

    Background: The river Gota Alv is a source of freshwater for 0.7 million swedes. The river is subject to contamination from sewer systems discharge and runoff from agricultural lands. Climate models projects an increase in precipitation and heavy rainfall in this region. This study aimed to determine how daily rainfall causes variation in indicators of pathogen loads, to increase knowledge of variations in river water quality and discuss implications for risk management. Methods: Data covering 7 years of daily monitoring of river water turbidity and concentrations of E. coli, Clostridium and coliforms were obtained, and their short-term variations in relation with precipitation were analyzed with time series regression and non-linear distributed lag models. We studied how precipitation effects varied with season and compared different weather stations for predictive ability. Results: Generally, the lowest raw water quality occurs 2 days after rainfall, with poor raw water quality continuing for several more days. A rainfall event of >15 mm/24-h (local 95 percentile) was associated with a three-fold higher concentration of E. coli and 30% higher turbidity levels (lag 2). Rainfall was associated with exponential increases in concentrations of indicator bacteria while the effect on turbidity attenuated with very heavy rainfall. Clear associations were also observed between consecutive days of wet weather and decreased water quality. The precipitation effect on increased levels of indicator bacteria was significant in all seasons. Conclusions: Rainfall elevates microbial risks year-round in this river and freshwater source and acts as the main driver of varying water quality. Heavy rainfall appears to be a better predictor of fecal pollution than water turbidity. An increase of wet weather and extreme events with climate change will lower river water quality even more, indicating greater challenges for drinking water producers, and suggesting better control of sources of pollution.

  • 271.
    Tornevi, Andreas
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Bergstedt, Olof
    Kretslopp och vatten, Göteborgs stad.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Tidsmässiga samband mellan nederbörd, råvattenkvalitet och magsjuka2015Report (Other academic)
    Abstract [en]

    Relations described between heavy rainfall, poor raw water quality and an increased number of cases of gastroenteritis in which the temporal delay is consistent with the incubation times of viruses. The report suggests that better protection against pollution in the river Göta Älv and improved barriers in drinking water production are justified.

  • 272.
    Tornevi, Andreas
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Simonsson, Magnus
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Säve-Söderbergh, Melle
    Toljander, Jonas
    Efficacy of water treatment processes and endemic gastrointestinal illness: A multi-city study in Sweden2016In: Water Research, ISSN 0043-1354, E-ISSN 1879-2448, Vol. 102, p. 263-270Article in journal (Refereed)
    Abstract [en]

    Outbreaks of acute gastrointestinal illnesses (AGI) have been linked to insufficient drinking water treatment on numerous occasions in the industrialized world, but it is largely unknown to what extent public drinking water influences the endemic level of AGI. This paper aimed to examine endemic AGI and the relationship with pathogen elimination efficacy in public drinking water treatment processes. For this reason, time series data of all telephone calls to the Swedish National Healthcare Guide between November 2007 and February 2014 from twenty Swedish cities were obtained. Calls concerning vomiting, diarrhea or abdominal pain (AGI calls) were separated from other concerns (non-AGI calls). Information on which type of microbial barriers each drinking water treatment plant in these cities have been used were obtained, together with the barriers' theoretical pathogen log reduction efficacy. The total log reduction in the drinking water plants varied between 0.0 and 6.1 units for viruses, 0.0-14.6 units for bacteria and 0.0-7.3 units regarding protozoans. To achieve one general efficacy parameter for each plant, a weighted mean value of the log reductions (WLR) was calculated, with the weights based on how commonly these pathogen groups cause AGI. The WLR in the plants varied between 0.0 and 6.4 units. The effect of different pathogen elimination efficacy on levels of AGI calls relative non-AGI calls was evaluated in regression models, controlling for long term trends, population size, age distribution, and climatological area. Populations receiving drinking water produced with higher total log reduction was associated with a lower relative number of AGI calls. In overall, AGI calls decreased by 4% (OR = 0.96, CI: 0.96-0.97) for each unit increase in the WLR. The findings apply to both groundwater and surface water study sites, but are particularly evident among surface water sites during seasons when viruses are the main cause of AGI. This study proposes that the endemic level of gastroenteritis can indeed be reduced with more advanced treatment processes at many municipal drinking water treatment plants.

  • 273. Torén, K
    et al.
    Gislason, T
    Omenaas, E
    Jögi, R
    Forsberg, B
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Nyström, Lennarth
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Olin, A-C
    Svanes, C
    Janson, C
    A prospective study of asthma incidence and its predictors: the RHINE study.2004In: Eur Respir J, ISSN 0903-1936, Vol. 24, no 6, p. 942-6Article in journal (Refereed)
  • 274. Touloumi, Giota
    et al.
    Samoli, Evangelia
    Quenel, Philippe
    Paldy, Anna
    Anderson, Ross H
    Zmirou, Dennis
    Galan, Igancio
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Occupational and Enviromental Medicine.
    Schindler, Christian
    Schwartz, Joel
    Katsouyanni, Klea
    Short-term effects of air pollution on total and cardiovascular mortality: the confounding effect of influenza epidemics.2005In: Epidemiology, ISSN 1044-3983, Vol. 16, no 1, p. 49-57Article in journal (Refereed)
  • 275. Triebner, Kai
    et al.
    Markevych, Iana
    Hustad, Steinar
    Benediktsdóttir, Bryndís
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Franklin, Karl A
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Gullón Blanco, José Antonio
    Holm, Mathias
    Jaquemin, Bénédicte
    Jarvis, Debbie
    Jõgi, Rain
    Leynaert, Bénédicte
    Lindberg, Eva
    Martínez-Moratalla, Jesús
    Muniozguren Agirre, Nerea
    Pin, Isabelle
    Sánchez-Ramos, José Luis
    Heinrich, Joachim
    Gómez Real, Francisco
    Dadvand, Payam
    Residential surrounding greenspace and age at menopause: A 20-year European study (ECRHS)2019In: Environment International, ISSN 0160-4120, E-ISSN 1873-6750, Vol. 132, article id 105088Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Menopause is associated with a number of adverse health effects and its timing has been reported to be influenced by several lifestyle factors. Whether greenspace exposure is associated with age at menopause has not yet been investigated.

    OBJECTIVE: To investigate whether residential surrounding greenspace is associated with age at menopause and thus reproductive aging.

    METHODS: This longitudinal study was based on the 20-year follow-up of 1955 aging women from a large, population-based European cohort (ECRHS). Residential surrounding greenspace was abstracted as the average of satellite-based Normalized Difference Vegetation Index (NDVI) across a circular buffer of 300 m around the residential addresses of each participant during the course of the study. We applied mixed effects Cox models with centre as random effect, menopause as the survival object, age as time indicator and residential surrounding greenspace as time-varying predictor. All models were adjusted for smoking habit, body mass index, parity, age at menarche, ever-use of contraception and age at completed full-time education as socio-economic proxy.

    RESULTS: An increase of one interquartile range of residential surrounding greenspace was associated with a 13% lower risk of being menopausal (Hazard Ratio: 0.87, 95% Confidence Interval: 0.79-0.95). Correspondingly the predicted median age at menopause was 1.4 years older in the highest compared to the lowest NDVI quartile. Results remained stable after additional adjustment for air pollution and traffic related noise amongst others.

    CONCLUSIONS: Living in greener neighbourhoods is associated with older age at menopause and might slow reproductive aging. These are novel findings with broad implications. Further studies are needed to see whether our findings can be replicated in different populations and to explore the potential mechanisms underlying this association.

  • 276. Valkonen, Maria
    et al.
    Täubel, Martin
    Pekkanen, Juha
    Tischer, Christina
    Rintala, Helena
    Zock, Jan-Paul
    Casas, Lidia
    Probst-Hensch, Nicole
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Holm, Mathias
    Janson, Christer
    Pin, Isabelle
    Gislason, Thorarinn
    Jarvis, Debbie
    Heinrich, Joachim
    Hyvärinen, Anne
    Microbial characteristics in homes of asthmatic and non-asthmatic adults in the ECRHS cohort2018In: Indoor Air, ISSN 0905-6947, E-ISSN 1600-0668, Vol. 28, no 1, p. 16-27Article in journal (Refereed)
    Abstract [en]

    Microbial exposures in homes of asthmatic adults have been rarely investigated; specificities and implications for respiratory health are not well understood. The objectives of this study were to investigate associations of microbial levels with asthma status, asthma symptoms, bronchial hyperresponsiveness (BHR), and atopy. Mattress dust samples of 199 asthmatics and 198 control subjects from 7 European countries participating in the European Community Respiratory Health Survey II study were analyzed for fungal and bacterial cell wall components and individual taxa. We observed trends for protective associations of higher levels of mostly bacterial markers. Increased levels of muramic acid, a cell wall component predominant in Gram-positive bacteria, tended to be inversely associated with asthma (OR's for different quartiles: II 0.71 [0.39-1.30], III 0.44 [0.23-0.82], and IV 0.60 [0.31-1.18] P for trend .07) and with asthma score (P for trend .06) and with atopy (P for trend .02). These associations were more pronounced in northern Europe. This study among adults across Europe supports a potential protective effect of Gram-positive bacteria in mattress dust and points out that this may be more pronounced in areas where microbial exposure levels are generally lower.

  • 277. Viana, M
    et al.
    Querol, X
    Götschi, T
    Alastuey, A
    Sunyer, J
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Heinrich, J
    Norbäck, D
    Payo, F
    Maldonado, JA
    Künzli, N
    Source apportionment of ambient PM2.5 at five Spanish centres of the European Community Respiratory Health Survey (ECRHS II)2007In: Atmospheric Environment, ISSN 1352-2310, E-ISSN 1873-2844, Vol. 41, no 7, p. 1395-1406Article in journal (Refereed)
    Abstract [en]

    Fine particulate matter (PM2.5) was sampled at 5 Spanish locations during the European Community Respiratory Health Survey II (ECRHS II). In an attempt to identify and quantify PM2.5 sources, source contribution analysis by principal component analysis (PCA) was performed on five datasets containing elemental composition of PM2.5 analysed by ED-XRF. A total of 4-5 factors were identified at each site, three of them being common to all sites (interpreted as traffic. mineral and secondary aerosols) whereas industrial sources were site-specific. Sea-salt was identified as independent source at all coastal locations except for Barcelona (where it was clustered with secondary aerosols). Despite their typically dominant coarse grain-size distribution, mineral and marine aerosols were clearly observed in PM2.5. Multi-linear regression analysis (MLRA) was applied to the data, showing that traffic was the main source of PM2.5 at the five sites (39-53% of PM2.5, 5.1-12.0 mu g m(-3)), while regional-scale secondary aerosols accounted for 14-34% of PM2.5 (2.6-4.5 mu g m(-3)), mineral matter for 13-31% (2.4-4.6 mu g m(-3)) and sea-salt made up 3-7% of the PM2.5 mass (0.4-1.3 mu g m(-3)). Consequently, despite regional and climatic variability throughout Spain, the same four main PM2.5 emission sources were identified at all the study sites and the differences between the relative contributions of each of these sources varied at most 20%. This would corroborate PM2.5 as a useful parameter for health studies and environmental policy-making, owing to the fact that it is not as subject to the influence of micro-sitting as other parameters such as PM10. African dust inputs were observed in the mineral source, adding on average 4-11 mu g m(-3) to the PM2.5 daily mean during dust outbreaks. On average, levels of Al, Si, Ti and Fe during African episodes were higher by a factor of 2-8 with respect to non-African days, whereas levels of local pollutants (absorption coefficient, S, Pb, Cl) showed smaller variations (factor of 0.5-2).

  • 278. Vicedo-Cabrera, A. M.
    et al.
    Guo, Y.
    Sera, F.
    Huber, V.
    Schleussner, C. -F
    Mitchell, D.
    Tong, S.
    Coelho, M. S. Z. S.
    Saldiva, P. H. N.
    Lavigne, E.
    Correa, P. M.
    Ortega, N. V.
    Kan, H.
    Osorio, S.
    KyselÜ, J.
    Urban, A.
    Jaakkola, J. J. K.
    Ryti, N. R. I.
    Pascal, M.
    Goodman, P. G.
    Zeka, A.
    Michelozzi, P.
    Scortichini, M.
    Hashizume, M.
    Honda, Y.
    Hurtado-Diaz, M.
    Cruz, J.
    Seposo, X.
    Kim, H.
    Tobias, A.
    Íñiguez, C.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Oudin Åström, Daniel
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Ragettli, M. S.
    Röösli, M.
    Guo, Y. L.
    Wu, C. -F
    Zanobetti, A.
    Schwartz, J.
    Bell, M. L.
    Dang, T. N.
    Do Van, D.
    Heaviside, C.
    Vardoulakis, S.
    Hajat, S.
    Haines, A.
    Armstrong, B.
    Ebi, K. L.
    Gasparrini, A.
    Temperature-related mortality impacts under and beyond Paris Agreement climate change scenarios2018In: Climatic Change, ISSN 0165-0009, E-ISSN 1573-1480, Vol. 150, no 3-4, p. 391-402Article in journal (Refereed)
    Abstract [en]

    The Paris Agreement binds all nations to undertake ambitious efforts to combat climate change, with the commitment to “hold warming well below 2 °C in global mean temperature (GMT), relative to pre-industrial levels, and to pursue efforts to limit warming to 1.5 °C”. The 1.5 °C limit constitutes an ambitious goal for which greater evidence on its benefits for health would help guide policy and potentially increase the motivation for action. Here we contribute to this gap with an assessment on the potential health benefits, in terms of reductions in temperature-related mortality, derived from the compliance to the agreed temperature targets, compared to more extreme warming scenarios. We performed a multi-region analysis in 451 locations in 23 countries with different climate zones, and evaluated changes in heat and cold-related mortality under scenarios consistent with the Paris Agreement targets (1.5 and 2 °C) and more extreme GMT increases (3 and 4 °C), and under the assumption of no changes in demographic distribution and vulnerability. Our results suggest that limiting warming below 2 °C could prevent large increases in temperature-related mortality in most regions worldwide. The comparison between 1.5 and 2 °C is more complex and characterized by higher uncertainty, with geographical differences that indicate potential benefits limited to areas located in warmer climates, where direct climate change impacts will be more discernible.

  • 279.
    Vicedo-Cabrera, Ana M
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland; .
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Tobias, Aurelio
    Barcelona, Spain.
    Zanobetti, Antonella
    Boston, Massachusetts.
    Schwartz, Joel
    Boston, Massachusetts.
    Armstrong, Ben
    London, United Kingdom.
    Gasparrini, Antonio
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom.
    Associations of Inter- and Intraday Temperature Change With Mortality2016In: American Journal of Epidemiology, ISSN 0002-9262, E-ISSN 1476-6256, Vol. 183, no 4, p. 286-293Article in journal (Refereed)
    Abstract [en]

    In this study we evaluated the association between temperature variation and mortality and compared it with the contribution due to mean daily temperature in 6 cities with different climates. Quasi-Poisson time series regression models were applied to estimate the associations (relative risk and 95% confidence interval) of mean daily temperature (99th and 1st percentiles, with temperature of minimum mortality as the reference category), interday temperature variation (difference between the mean temperatures of 2 neighboring days) and intraday temperature variation (diurnal temperature range (DTR)) (referred to as median variation) with mortality in 6 cities: London, United Kingdom; Madrid, Spain; Stockholm, Sweden; New York, New York; Miami, Florida; and Houston, Texas (date range, 1985-2010). All cities showed a substantial increase in mortality risk associated with mean daily temperature, with relative risks reaching 1.428 (95% confidence interval (CI): 1.329, 1.533) for heat in Madrid and 1.467 (95% CI: 1.385, 1.555) for cold in London. Inconsistent results for inter-/intraday change were obtained, except for some evidence of protective associations on hot and cold days (relative risk (RR) = 0.977 (95% CI: 0.955, 0.999) and RR = 0.981 (95% CI: 0.971, 0.991), respectively) in Madrid and on cold days in Stockholm (RR = 0.989, 95% CI: 0.980, 0.998). Our results indicate that the association between mortality and temperature variation is generally minimal compared with mean daily temperatures, although further research on intraday changes is needed.

  • 280.
    Vicedo-Cabrera, Ana M.
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Olsson, David
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Exposure to Seasonal Temperatures during the Last Month of Gestation and the Risk of Preterm Birth in Stockholm2015In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 12, no 4, p. 3962-3978Article in journal (Refereed)
    Abstract [en]

    Recent evidence from studies performed mainly in warm climates suggests an association between exposure to extreme temperatures late in pregnancy and an increased risk of preterm delivery. However, there have been fewer studies on the effect of low temperatures. The aim of this study is to explore the potential association between both heat and cold during late pregnancy and an increased risk of preterm birth in the northern location of Stockholm, Sweden. All singleton spontaneous births that took place in greater Stockholm (1998-2006) were included. Non-linear and delayed effects of mean temperature on the risk of preterm birth were explored through distributed lag non-linear models. Extreme and moderate heat and cold were estimated separately through quasi-Poisson regression analysis in two seasonal periods (heat in warm season, cold in cold season). The risk of preterm birth increased by 4%-5% when the mean temperature reached the 75th percentile (moderate heat) four weeks earlier (reference: the annual median value), with a maximum cumulative risk ratio of 2.50 (95% confidence interval: 1.02-6.15). Inconsistent associations were obtained for cold and extreme heat. Exposure to moderately high temperatures during late pregnancy might be associated with an increase in risk of preterm birth in Stockholm.

  • 281. Vicedo-Cabrera, Ana M
    et al.
    Sera, Francesco
    Liu, Cong
    Armstrong, Ben
    Milojevic, Ai
    Guo, Yuming
    Tong, Shilu
    Lavigne, Eric
    Kyselý, Jan
    Urban, Aleš
    Orru, Hans
    Indermitte, Ene
    Pascal, Mathilde
    Huber, Veronika
    Schneider, Alexandra
    Katsouyanni, Klea
    Samoli, Evangelia
    Stafoggia, Massimo
    Scortichini, Matteo
    Hashizume, Masahiro
    Honda, Yasushi
    Ng, Chris Fook Sheng
    Hurtado-Diaz, Magali
    Cruz, Julio
    Silva, Susana
    Madureira, Joana
    Scovronick, Noah
    Garland, Rebecca M
    Kim, Ho
    Tobias, Aurelio
    Íñiguez, Carmen
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Åström, Christofer
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Ragettli, Martina S
    Röösli, Martin
    Guo, Yue-Liang Leon
    Chen, Bing-Yu
    Zanobetti, Antonella
    Schwartz, Joel
    Bell, Michelle L
    Kan, Haidong
    Gasparrini, Antonio
    Short term association between ozone and mortality: global two stage time series study in 406 locations in 20 countries2020In: BMJ. British Medical Journal, E-ISSN 1756-1833, Vol. 368, article id m108Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To assess short term mortality risks and excess mortality associated with exposure to ozone in several cities worldwide.

    DESIGN: Two stage time series analysis.

    SETTING: 406 cities in 20 countries, with overlapping periods between 1985 and 2015, collected from the database of Multi-City Multi-Country Collaborative Research Network.

    POPULATION: Deaths for all causes or for external causes only registered in each city within the study period. MAIN OUTCOME MEASURES: Daily total mortality (all or non-external causes only).

    RESULTS: A total of 45 165 171 deaths were analysed in the 406 cities. On average, a 10 µg/m3 increase in ozone during the current and previous day was associated with an overall relative risk of mortality of 1.0018 (95% confidence interval 1.0012 to 1.0024). Some heterogeneity was found across countries, with estimates ranging from greater than 1.0020 in the United Kingdom, South Africa, Estonia, and Canada to less than 1.0008 in Mexico and Spain. Short term excess mortality in association with exposure to ozone higher than maximum background levels (70 µg/m3) was 0.26% (95% confidence interval 0.24% to 0.28%), corresponding to 8203 annual excess deaths (95% confidence interval 3525 to 12 840) across the 406 cities studied. The excess remained at 0.20% (0.18% to 0.22%) when restricting to days above the WHO guideline (100 µg/m3), corresponding to 6262 annual excess deaths (1413 to 11 065). Above more lenient thresholds for air quality standards in Europe, America, and China, excess mortality was 0.14%, 0.09%, and 0.05%, respectively.

    CONCLUSIONS: Results suggest that ozone related mortality could be potentially reduced under stricter air quality standards. These findings have relevance for the implementation of efficient clean air interventions and mitigation strategies designed within national and international climate policies.

  • 282. Vineis, Paolo
    et al.
    Hoek, Gerard
    Krzyzanowski, Michal
    Vigna-Taglianti, Federica
    Veglia, Fabrizio
    Airoldi, Luisa
    Autrup, Herman
    Dunning, Alison
    Garte, Seymour
    Hainaut, Pierre
    Malaveille, Christian
    Matullo, Giuseppe
    Overvad, Kim
    Raaschou-Nielsen, Ole
    Clavel-Chapelon, Francoise
    Linseisen, Jacob
    Boeing, Heiner
    Trichopoulou, Antonia
    Palli, Domenico
    Peluso, Marco
    Krogh, Vittorio
    Tumino, Rosario
    Panico, Salvatore
    Bueno-De-Mesquita, H Bas
    Peeters, Petra H
    Lund, E Eylin
    Gonzalez, Carlos A
    Martinez, Carmen
    Dorronsoro, Miren
    Barricarte, Aurelio
    Cirera, Lluis
    Quiros, J Ramon
    Berglund, Goran
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Occupational and Enviromental Medicine.
    Day, Nicholas E
    Key, Tim J
    Saracci, Rodolfo
    Kaaks, Rudolf
    Riboli, Elio
    Air pollution and risk of lung cancer in a prospective study in Europe.2006In: Int J Cancer, ISSN 0020-7136, Vol. 119, no 1, p. 169-74Article in journal (Refereed)
  • 283. Vineis, Paolo
    et al.
    Hoek, Gerard
    Krzyzanowski, Michal
    Vigna-Taglianti, Federica
    Veglia, Fabrizio
    Airoldi, Luisa
    Overvad, Kim
    Raaschou-Nielsen, Ole
    Clavel-Chapelon, Francoise
    Linseisen, Jacob
    Boeing, Heiner
    Trichopoulou, Antonia
    Palli, Domenico
    Krogh, Vittorio
    Tumino, Rosario
    Panico, Salvatore
    Bueno-De-Mesquita, H Bas
    Peeters, Petra H
    Lund E, Eiliv
    Agudo, Antonio
    Martinez, Carmen
    Dorronsoro, Miren
    Barricarte, Aurelio
    Cirera, Lluis
    Quiros, J Ramon
    Berglund, Goran
    Manjer, Jonas
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Occupational and Enviromental Medicine.
    Day, Nicholas E
    Key, Tim J
    Kaaks, Rudolf
    Saracci, Rodolfo
    Riboli, Elio
    Lung cancers attributable to environmental tobacco smoke and air pollution in non-smokers in different European countries: a prospective study.2007In: Environmental health : a global access science source, ISSN 1476-069X, p. 6-7Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Several countries are discussing new legislation on the ban of smoking in public places, and on the acceptable levels of traffic-related air pollutants. It is therefore useful to estimate the burden of disease associated with indoor and outdoor air pollution. METHODS: We have estimated exposure to Environmental Tobacco Smoke (ETS) and to air pollution in never smokers and ex-smokers in a large prospective study in 10 European countries (European Prospective Investigation into Cancer and Nutrition)(N = 520,000). We report estimates of the proportion of lung cancers attributable to ETS and air pollution in this population. RESULTS: The proportion of lung cancers in never- and ex-smokers attributable to ETS was estimated as between 16 and 24%, mainly due to the contribution of work-related exposure. We have also estimated that 5-7% of lung cancers in European never smokers and ex-smokers are attributable to high levels of air pollution, as expressed by NO2 or proximity to heavy traffic roads. NO2 is the expression of a mixture of combustion (traffic-related) particles and gases, and is also related to power plants and waste incinerator emissions. DISCUSSION: We have estimated risks of lung cancer attributable to ETS and traffic-related air pollution in a large prospective study in Europe. Information bias can be ruled out due to the prospective design, and we have thoroughly controlled for potential confounders, including restriction to never smokers and long-term ex-smokers. Concerning traffic-related air pollution, the thresholds for indicators of exposure we have used are rather strict, i.e. they correspond to the high levels of exposure that characterize mainly Southern European countries (levels of NO2 in Denmark and Sweden are closer to 10-20 ug/m3, whereas levels in Italy are around 30 or 40, or higher).Therefore, further reduction in exposure levels below 30 ug/m3 would correspond to additional lung cancer cases prevented, and our estimate of 5-7% is likely to be an underestimate. Overall, our prospective study draws attention to the need for strict legislation concerning the quality of air in Europe.

  • 284.
    Åström, Christofer
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Bjelkmar, Pär
    Folkhälsomyndighe-ten, Stockholm.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Ovanligt många dödsfalli Sverige sommaren 2018: drygt 600 kan ha dött till följd av värmeböljan2019In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 116, article id FLFHArticle in journal (Refereed)
  • 285.
    Åström, Christofer
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Ebi, Kristie L
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Langner, Joakim
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Developing a heatwave early warning system for Sweden: evaluating sensitivity of different epidemiological modelling approaches to forecast temperatures2015In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 12, no 1, p. 254-267Article in journal (Refereed)
    Abstract [en]

    Over the last two decades a number of heatwaves have brought the need for heatwave early warning systems (HEWS) to the attention of many European governments. The HEWS in Europe are operating under the assumption that there is a high correlation between observed and forecasted temperatures. We investigated the sensitivity of different temperature mortality relationships when using forecast temperatures. We modelled mortality in Stockholm using observed temperatures and made predictions using forecast temperatures from the European Centre for Medium-range Weather Forecasts to assess the sensitivity. We found that the forecast will alter the expected future risk differently for different temperature mortality relationships. The more complex models seemed more sensitive to inaccurate forecasts. Despite the difference between models, there was a high agreement between models when identifying risk-days. We find that considerations of the accuracy in temperature forecasts should be part of the design of a HEWS. Currently operating HEWS do evaluate their predictive performance; this information should also be part of the evaluation of the epidemiological models that are the foundation in the HEWS. The most accurate description of the relationship between high temperature and mortality might not be the most suitable or practical when incorporated into a HEWS.

  • 286.
    Åström, Christofer
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Orru, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. orru@ut.ee.
    Rocklöv, Joacim
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Strandberg, Gustav
    Rossby Centre, SMHI, Norrköping, Sweden.
    Ebi, Kristie L
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Heat-related respiratory hospital admissions in Europe in a changing climate: a health impact assessment2013In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 3, no 1, p. e001842-Article in journal (Refereed)
    Abstract [en]

    Objectives Respiratory diseases are ranked second in Europe in terms of mortality, prevalence and costs. Studies have shown that extreme heat has a large impact on mortality and morbidity, with a large relative increase for respiratory diseases. Expected increases in mean temperature and the number of extreme heat events over the coming decades due to climate change raise questions about the possible health impacts. We assess the number of heat-related respiratory hospital admissions in a future with a different climate.                                

    Design A Europe-wide health impact assessment.                                

    Setting An assessment for each of the EU27 countries.                                

    Methods Heat-related hospital admissions under a changing climate are projected using multicity epidemiological exposure–response relationships applied to gridded population data and country-specific baseline respiratory hospital admission rates. Times-series of temperatures are simulated with a regional climate model based on four global climate models, under two greenhouse gas emission scenarios.                                

    Results Between a reference period (1981–2010) and a future period (2021–2050), the total number of respiratory hospital admissions attributed to heat is projected to be larger in southern Europe, with three times more heat attributed respiratory hospital admissions in the future period. The smallest change was estimated in Eastern Europe with about a twofold increase. For all of Europe, the number of heat-related respiratory hospital admissions is projected to be 26 000 annually in the future period compared with 11 000 in the reference period.                                

    Conclusions The results suggest that the projected effects of climate change on temperature and the number of extreme heat events could substantially influence respiratory morbidity across Europe.                                

     

  • 287.
    Åström, Christofer
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Oudin Åström, Daniel
    Lund Universitet.
    Andersson, Camilla
    SMHI.
    Ebi, Kristie L.
    University of Washington.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Future health impact of higher ambient temperatures in Stockholm, SwedenManuscript (preprint) (Other academic)
  • 288.
    Åström, Christofer
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Oudin Åström, Daniel
    Lund Universitet.
    Andersson, Camilla
    SMHI.
    Ebi, Kristie L.
    University of Washington.
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Vulnerability reduction needed to adapt to projected future heat exposure in Europe: Magnitude and determinantsManuscript (preprint) (Other academic)
  • 289.
    Åström, Christofer
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Åström, Daniel Oudin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden.
    Andersson, Camilla
    Ebi, Kristie L
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Vulnerability Reduction Needed to Maintain Current Burdens of Heat-Related Mortality in a Changing Climate-Magnitude and Determinants2017In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 14, no 7, article id 741Article in journal (Refereed)
    Abstract [en]

    The health burden from heatwaves is expected to increase with rising global mean temperatures and more extreme heat events over the coming decades. Health-related effects from extreme heat are more common in elderly populations. The population of Europe is rapidly aging, which will increase the health effects of future temperatures. In this study, we estimate the magnitude of adaptation needed to lower vulnerability to heat in order to prevent an increase in heat-related deaths in the 2050s; this is the Adaptive Risk Reduction (ARR) needed. Temperature projections under Representative Concentration Pathway (RCP) 4.5 and RCP 8.5 from 18 climate models were coupled with gridded population data and exposure-response relationships from a European multi-city study on heat-related mortality. In the 2050s, the ARR for the general population is 53.5%, based on temperature projections under RCP 4.5. For the population above 65 years in Southern Europe, the ARR is projected to be 45.9% in a future with an unchanged climate and 74.7% with climate change under RCP 4.5. The ARRs were higher under RCP 8.5. Whichever emission scenario is followed or population projection assumed, Europe will need to adapt to a great degree to maintain heat-related mortality at present levels, which are themselves unacceptably high, posing an even greater challenge.

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